________________________________________________________________________________________
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION
PLEASE REVIEW IT CAREFULLY
Effective Date: April 14, 2003
If you have any questions about this notice, please
contact the Hospital’s Privacy Officer.
This
notice describes
·
Any healthcare professional authorized to enter information
into your hospital medical record.
·
All departments and units of the hospital.
·
Any member of a volunteer group we allow to help you while
you are in the hospital.
·
All employees, staff and other hospital personnel.
All
these persons, entities, sites, and locations follow the terms of this
notice. In addition, these persons,
entities, sites, and locations may share medical information with each other
for treatment, payment, or hospital operations purposes as described in this
notice.
We understand that medical information
about you and your health is personal. We
are committed to protecting medical information about you.
We create a record of the care and services you receive at the hospital.
We need this record to provide you with quality care and to comply
with certain legal requirements. This notice applies to all of the records of
your care generated by the hospital, whether made by hospital personnel or
your personal doctor at the hospital. Your
personal doctor may have different policies or notices regarding the doctor’s
use and disclosure of your medical information created in the doctor’s office
or clinic.
Version 1.1 (4/2003)
This
notice will tell you about the ways in which we may use and disclose medical
information about you. We also describe
your rights and certain obligations we have regarding the use and disclosure of
medical information.
We are required by law to:
·
Make sure that medical information that identifies you is
kept private;
·
Give you this notice of our legal duties and privacy
practices with respect to medical information about you; and
·
Follow the terms of the notice that are currently in effect.
The following categories describe different ways that
we use and disclose medical information.
For each category of uses or disclosures we will explain what we mean
and try to give some examples. Not every
use or disclosure in a category will be listed.
However, all of the ways we are permitted to use and disclose
information will fall within one of these categories.
Ø
For Treatment. We may use medical information about you to
provide you with medical treatment or services.
We may disclose medical information about you to doctors, nurses,
technicians, medical students, or other hospital personnel who are involved in
taking care of you at the hospital. For
example, a doctor treating you for a broken hip may need to know if you have
diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the
dietitian if you have diabetes so that we can arrange for appropriate meals. We also may disclose medical information
about you to people outside the hospital who may be involved in your medical
care after you leave the hospital, such as family members, clergy, or others we
use to provide services that are part of your care, such as therapists or
physicians. For instance, we may send
your doctor the results of laboratory tests we perform.
Ø
For Payment. We may use and disclose medical information
about you so that the treatment and services you receive at the hospital may be
billed and payment may be collected from you, an insurance company, or a third
party. For example, we may need to give
your health plan information about treatment you received at the hospital so
your health plan will pay us or reimburse you for the treatment. We may also tell your health plan about a
treatment you are going to receive to obtain prior approval or to determine
whether your plan will cover the treatment.
We also may disclose information about you to another health care
provider, such as another hospital, for their payment activities concerning
you. We will not use or disclose more
information for payment purposes than is necessary.
Ø
For Healthcare Operations. We may use and disclose medical information
about you for hospital operations. These
uses and disclosures are necessary to run the hospital and make sure that all
of our patients receive quality care.
For example, we may use medical information to review our treatment and
services and to evaluate the performance of our staff in caring for you. We may also combine medical information about
many hospital patients to decide what additional services the hospital should
offer, what services are not needed, and whether certain new treatments are
effective. We may also disclose
information to doctors, nurses, technicians, medical students, and other
hospital personnel for review and learning purposes. We may also combine the medical information
we have with medical information from other hospitals to compare how we are
doing and see where we can make improvements in the care and services we
offer. We may remove information that
identifies you from this set of medical information so others may use it to
study health care and healthcare delivery without learning the identities of
specific patients. We may disclose your
health information as necessary to others who we contract with to provide
administrative services such as our auditors, accreditation services, and
consultants. We may also disclose
information about you for another hospital’s health care operations if you also
have received care at that hospital.
Ø
Treatment Alternatives. We may use and disclose medical information
to tell you about or recommend different ways to treat you.
Ø
Health-Related Benefits and
Services. We may use and disclose medical information
to tell you about health-related benefits or services that may be of interest
to you.
Ø Fundraising Activities. We may use
medical information about you to contact you in an effort to raise money for
the hospital and its operations. We may
disclose medical information to a business partner or a foundation related to
the hospital so that the business partner or the foundation may contact you in
raising money for the hospital. We only
would release contact information, such as your name, address and phone number,
and the dates you received treatment or services at the hospital.
If you do not want the hospital to contact you for fundraising efforts, you
must notify the hospital’s Privacy Officer in writing.
Ø Hospital Directory. Unless you tell us otherwise, we may include
certain limited information about you in the hospital directory while you are a
patient at the hospital. This
information may include your name, location in the hospital, your general
condition (e.g., fair, stable, etc.), and your religious affiliation. The directory information, except for your
religious affiliation, may also be released to people who ask for you by
name. Your religious affiliation may be
given to a member of the clergy, such as a priest or rabbi, even if they don’t
ask for you by name. This is so your
family, friends, and clergy can visit you in the hospital and generally know
how you are doing.
If you do not want anyone
to know this information about you, if you want to limit the amount of
information that is disclosed, or if you want to limit who gets this
information, you must notify the hospital’s Privacy Officer in writing or
indicate your preference on the Hospital’s Patient Directory Instructions Form
that you will receive when you are registered.
Ø
Individuals Involved in Your
Care or Payment for Your Care. We may
release medical information about you to a friend or family member who is
involved in your medical care. This
would include persons named in any durable health care power of attorney or
similar document provided to us or persons appointed by a physician to serve as
a health care surrogate. We may also
give information to someone who helps pay for your care. In addition, we may disclose medical
information about you to an entity assisting in a disaster relief effort so
that your family can be notified about your condition, status, and
location. You can object to these
releases by telling us that you do not wish any or all individuals involved in
your care to receive this information.
If you are not present or cannot agree or object, we will use our
professional judgment to decide whether it is in your best interest to release
relevant information to someone who is involved in your care or to an entity
assisting in a disaster relief effort.
Ø
Appointments. We contact you to provide appointment
reminders or other health-related benefits and services that may be of interest
to you.
Ø
Research. Under certain
circumstances, we may use and disclose medical information about you for
research purposes. For example, a research
project may involve comparing the health and recovery of all patients who
received one medication to those who received another for the same
condition. All research projects,
however, are subject to a special approval process. This process evaluates a proposed research
project and its use of medical information, trying to balance the research
needs with patients’ need for privacy of their medical information. Before we use or disclose medical information
for research, the project will have been approved through this research
approval process. We may, however,
disclose medical information about you to people preparing to conduct a
research project, for example, to help them look for patients with specific
medical needs, so long as the medical information they review does not leave
the hospital.
Ø
As Required By Law. We will disclose
medical information about you when required to do so by federal, state, or
local law.
Ø
To Avert a Serious Threat
to Health or Safety. We may use and disclose medical information about you
when necessary to prevent a serious threat to your health and safety or the
health and safety of the public or another person. Any disclosure, however, would only be to
someone able to help prevent the threat.
Ø Organ and Tissue Donation. If you are an organ donor, we may release
medical information to organizations that handle organ procurement or organ,
eye, or tissue transplantation, or to an organ donation bank as necessary to
facilitate organ or tissue donation and transplantation.
Ø
Military and Veterans. If you are a member of the armed forces, we
may release medical information about you as required by military command
authorities. We may also release medical
information about foreign military personnel to the appropriate foreign
military authority. We may use and
disclose to components of the Department of Veterans Affairs medical
information about you to determine whether you are eligible for certain
benefits.
Ø
Workers’ Compensation. We may release
medical information about you for Workers’ Compensation or similar
programs. These programs provide
benefits for work-related injuries or illness.
Ø Public Health Risks. We may disclose medical information about you
for public health activities. These
activities generally include the following:
·
To prevent or control disease, injury, or disability;
·
To report deaths;
·
To report reactions to medications or problems with
products; to notify people of recalls of products they may be using;
·
To notify a person who may have been exposed to a disease or
may be at risk for contracting or spreading a disease or condition; and
·
To notify the appropriate government authority if we believe
a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you
agree or when required or authorized by law.
Ø Health Oversight Activities. We may disclose
medical information to a health oversight agency for activities authorized by
law. These oversight activities include,
for example, audits, investigations, inspections, and licensure. These activities are necessary for the
government to monitor the healthcare system, government programs, and
compliance with civil rights laws.
Ø Lawsuits and Disputes. If you are
involved in a lawsuit or a dispute, we may disclose medical information about
you in response to a court or administrative order. We may also disclose medical information
about you in response to a subpoena, discovery request, or other lawful process
by someone else involved in the dispute, but only if efforts have been made to
tell you about the request or to obtain an order protecting the information
requested.
Ø Law Enforcement. We may
release medical information if asked to do so by a law enforcement official:
·
In response to a court order, subpoena, warrant, summons, or
similar process;
·
To identify or locate a suspect, fugitive, material witness,
or missing person;
·
About the victim of a crime if, under certain limited
circumstances, we are unable to obtain the person’s agreement;
·
About a death we believe may be the result of criminal
conduct;
·
About criminal conduct at the hospital; and
·
In emergency circumstances to report a crime; the location
of the crime or victims; or the identity, description, or location of the
person who committed the crime.
Ø
Coroners, Medical
Examiners, and Funeral Directors. We may
release medical information to a coroner or medical examiner. This may be necessary, for example, to
identify a deceased person or determine the cause of death. We may also release medical information about
deceased patients of the hospital to funeral directors as necessary to carry
out their duties.
Ø
National Security and
Intelligence Activities. We may release
medical information about you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by law.
Ø
Protective Services for the
President and Others. We may disclose medical information about you
to authorized federal officials so they may provide protection to the
President, other authorized persons, or foreign heads of state, or to conduct
special investigations.
Ø
Inmates. If you are an inmate
of a correctional institution or under the custody of a law enforcement
official, we may release medical information about you to the correctional
institution or law enforcement official.
This release would be necessary (1) for the institution to provide you
with health care; (2) to protect your health and safety or the health and
safety of others; (3) for the safety and security of the correctional
institution; or (4) to obtain payment for services provided to you.
You have the following rights regarding medical information we maintain
about you:
Ø
Right to Inspect and Copy. You have the right to inspect and receive a
copy of medical information that may be used to make decisions about your
care. Usually, this includes medical and
billing records, but does not include psychotherapy notes and other mental
health records under certain circumstances.
To
inspect and receive a copy of medical information that may be used to make
decisions about you, you must submit your request in writing to the Health
Information Management Department. If
you request a copy of the information, we may charge a fee for the costs of
copying, mailing, or other supplies associated with your request.
We
may deny your request to inspect and copy your medical information in certain
very limited circumstances, such as when your physician determines that for
medical reasons this is not advisable. If we do, we will give you the reason,
in writing. We will also explain how you
may appeal this decision.
Ø
Right to Amend. You have the right to ask us to amend health
information about you which you believe is not correct, or not complete. You must make this request in writing and
give us the reason why you believe the information is not correct or
complete. We will respond to your
request in writing within 30 days. We
may deny your request if we did not create the information, if it is not part
of the records we use to make decisions about you, if the information is
something you would not be permitted to inspect or copy, or if it is complete
and accurate.
Ø
Right to an Accounting of
Disclosures. You have the right to request
an “accounting of disclosures.” This is
a list of some of the disclosures we made of medical information about you that
were not specifically authorized by you in advance.
To
request this list or accounting of disclosures, you must submit your request in
writing to the Health Information Management Department. Your request must state a time period that
may not be longer than six years and may not include dates before April 14,
2003. The first list you request within
a 12-month period will be free. For
additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved, and
you may choose to withdraw or modify your request at that time before any costs
are incurred. Disclosures for the
following reasons will not be included on the list: disclosures for treatment, payment health
care operations; disclosures of
information in a facility directory, disclosures for national security
purposes, disclosures to correctional or law enforcement personnel, disclosures
that you have authorized, and disclosures made directly to you.
Ø
Right to Request
Restrictions. You have the right to request a
restriction or limitation on the medical information we use or disclose about
you for treatment, payment, or healthcare operations. You also have the right to request a
limitation on the medical information we disclose about you to someone who is
involved in your care or the payment for your care, like a family member or
friend.
Ø
Right to Revoke
Authorization. You may revoke an authorization
to use or disclose health information, except to the extent that action has
already been taken. Such a request must
be made in writing.
We are not required to agree to your request. If we do agree, we
will comply with your request unless the information is needed to provide you
emergency treatment.
To
request restrictions, you must make your request in writing to the Hospital’s
Privacy Officer. In your request, you
must tell us (1) what information you want to limit; (2) whether you want to
limit our use, disclosure, or both; and (3) to whom you want the limits to
apply, for example, disclosures to your spouse.
Ø
Right to Confidential Communication. You have the right to request to receive
communications from us on a confidential basis by using alternative means for
receipt of information or by receiving the information at alternative
locations. For example, you can ask that
we only contact you at work or by mail, or at another mailing address, besides
your home address. We must accommodate
your request, if it is reasonable. You
are not required to provide us with an explanation as to the reason for your
request. Contact the Privacy Officer if
you require such confidential communications.
Ø
Right to a Paper Copy of
This Notice. You have the right to a paper
copy of this notice. Copies of this
notice are available in the registration areas. You may ask us to give you a
copy of this notice at any time. If you
wish to receive this notice electronically, you are still entitled to a paper
copy of this notice. This notice is also
available on our web site:
www.jeffmem.com.
We reserve the right to
change this notice. We reserve the right
to make the revised or changed notice effective for medical information we
already have about you as well as any information we receive in the
future. We will post a copy of the
current notice in the hospital. The
notice will contain on the first page, in the top right-hand corner, the
effective date. With the distribution of
each Notice of Privacy Practices, the recipient patient or personal
representative will be asked to sign a form acknowledging receipt of the
notice.
If you believe your privacy rights have been
violated, you may file a complaint with the hospital or with the Secretary of
the Department of Health and Human Services.
To file a complaint with the hospital, contact the Privacy Officer, 300
S. Preston Street, Ranson, WV 25438 (304-728-1600), who is responsible for handling
complaints. All complaints must be
submitted in writing.
You will not be penalized for filing a complaint.
Other
uses and disclosures of medical information not covered by this notice or the
laws that apply to us will be made only with your written permission. If you provide us permission to use or
disclose medical information about you, you may revoke that permission, in
writing, at any time. If you revoke your
permission, we will no longer use or disclose medical information about you for
the reasons covered by your written authorization. You understand that we are unable to take
back any disclosures we have already made with your permission and that we are
required to retain our records of the care that we provided to you.